Blixen Carol, Sajatovic Martha, Moore David J, Depp Colin, Cushman Clint, Cage Jamie, Barboza Marina, Eskew Logan, Klein Peter, Levin Jennifer B
Department of Psychiatry, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, Cleveland, Ohio, USA.
Department of Psychiatry, Case Western Reserve University School of Medicine, Department of Psychiatry; University Hospitals Cleveland Medical Center; Neurological and Behavioral Outcomes Center, Cleveland, Ohio, USA.
Int J Healthc. 2018;4(1):25-35. doi: 10.5430/ijh.v4n1p25.
Individuals living with bipolar disorder (BD) have poorer management of chronic medical conditions such as hypertension (HTN), and worse treatment adherence than the general population. The study objective was to obtain information from patients with both BD and HTN that would inform the development of an m-Health intervention to improve medication adherence for poorly adherent individuals living with both these chronic illnesses.
Focus group methodology was used to collect information from 13 participants on perceived barriers and facilitators to BD and HTN medication adherence, as well as feedback on the demonstration and use of a bidirectional text messaging system for medication reminders. Focus groups were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes.
Forgetfulness was the most frequently mentioned barrier to taking antihypertensive medications, and decisions about taking them were often influenced by BD mood fluctuations and the burden of having to take for both chronic illnesses. Participants' feedback about the use of a text-messaging system to help with medication adherence for BD and HTN was very positive, and their suggestions for modification were incorporated into a more customized system for testing in a Phase 2 trial.
Our findings indicate that patient engagement in the development of an m-health intervention has the potential to improve adherence with both BD and HTN medications in individuals with known sub-optimal adherence. Patient engagement in health care is essential if we are to optimize patient outcomes.
双相情感障碍（BD）患者对高血压（HTN）等慢性疾病的管理较差，且治疗依从性比普通人群更差。本研究的目的是从同时患有BD和HTN的患者那里获取信息，为开发一种移动健康干预措施提供依据，以提高患有这两种慢性病且依从性差的患者的药物依从性。
采用焦点小组方法，从13名参与者那里收集关于BD和HTN药物依从性的感知障碍和促进因素的信息，以及关于用于药物提醒的双向短信系统的演示和使用的反馈。焦点小组进行了录音，逐字转录，并采用内容分析法进行分析，重点关注主要主题。
健忘是服用抗高血压药物最常被提及的障碍，服用药物的决定往往受到BD情绪波动以及必须同时服用两种慢性病药物的负担的影响。参与者对使用短信系统帮助BD和HTN患者坚持服药的反馈非常积极，他们的修改建议被纳入一个更定制化的系统，以便在二期试验中进行测试。
我们的研究结果表明，让患者参与移动健康干预措施的开发有可能提高已知依从性欠佳的个体对BD和HTN药物的依从性。如果我们要优化患者的治疗效果，患者参与医疗保健至关重要。
